Healthcare Provider Details

I. General information

NPI: 1033553037
Provider Name (Legal Business Name): CHARLENE H VROOMAN R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/20/2013
Last Update Date: 04/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14 ELM ST
COOPERSTOWN NY
13326-1214
US

IV. Provider business mailing address

14 ELM ST
COOPERSTOWN NY
13326-1214
US

V. Phone/Fax

Practice location:
  • Phone: 978-727-2819
  • Fax:
Mailing address:
  • Phone: 978-727-2819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number599403-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number599403-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: